Discussion 28 Paper: Adjectives
Discussion 28 Paper: Adjectives
Provide examples of the adjectives mentioned in the workshop.
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NCLEXStrategiesmodule2ongoing-Copy.pptxNCLEX Strategies: Getting ready
By: Guillermo Londono RN, MSN/MHA
Dean / Director of Nursing at Censa International College (CIC)
June 5, 2017
NCLEX Strategies
Objectives:
More Strategy learning aids:
Critical thinking
Strategy steps:
What is the question really asking?
Look for hints:
The adjectives
The phrase further teaching
The phrase client understands
Reword the question
Find clues if any
NCLEX Strategies
Getting ready Strategies
The NCLEX-RN exam is not a test about recognizing facts.
You must be able to correctly identify what the question is asking.
Do not focus on background information that is not needed to answer the question.
The NCLEX-RN exam focuses on thinking through a problem or situation.
NCLEX Strategies
The anatomy of an NCLEX-RN question:
Item: the entire question and answer
Stem: the actual question, what is being asked
Options: possible responses
Correct answer: the correct answer
Distractors: incorrect answers
NCLEX Strategies
Stem:
The stem will have a few characteristics that you must consider.
Complete sentence
Incomplete sentence – becomes complete with the correct answer
Positive – asks a question regarding what is true
Negative – asks a question regarding what is false.
Note of caution:
Be very careful with these negative questions.
These tend to be missed more often simply because students fail to read the entire question.
ALWAYS read the entire stem carefully and completely.
NCLEX Strategies
Look for these words when determining if the stem is negative:
Except
Not/is not
Never
Further/ needs further
Least
Avoid/avoided
Contraindicated
Ineffective
There are a few app questions in particular that are missed on a daily basis by users and it is always due to reading the question incorrectly.
These are not difficult questions, but they are consistently missed. Here are some examples:
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NCLEX Strategies
Example question: “A patient is admitted to the hospital with an INR of 3.9, history of a GI bleed, and osteomyelitis. The patient is complaining of bone pain, so the nurse prepares to administer morphine. Which route should be avoided?”
A. PO
B. IV
C. IM
D. SQ
How would you answer this question?
With an elevated INR of 3.9, the patient is at risk for bleeding. Muscles are highly vascular and should be avoided due to the bleeding risk
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NCLEX Strategies
Example question #2: A patient is diagnosed with an infection caused by the hepatitis A virus. Which statement, if made by the patient, would indicate the patient needs further teaching about the infection?
A. “It’s important for me to remember to wash my hands after I use the bathroom.”
B. “I might get liver cancer someday because I have this infection.”
C “Before I take any over-the-counter medicines I should call the clinic.”
D “I will wash raw fruits and vegetables thoroughly before I eat them.”
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NCLEX Strategies
Remember, the NCLEX-RN exam is testing your ability to think critically.
Critical thinking for the nurse involves the following:
Observation
Deciding what is important
Looking for patterns and relationships
Identifying the problem
Transferring knowledge from one situation to another
Applying knowledge
Discriminating between possible choices and/or courses of action
Evaluating according to criteria established
NCLEX Strategies
More Strategy learning aids:
The first step to correctly answering NCLEX-RN exam questions is to find out what each question is really asking.
Read each question carefully from the first word to the last word.
Read them carefully and slowly pace.
Second step: Look for hints in the wording of the question stem.
The adjectives most, first, best, primary, and initial indicate that you must establish priorities.
The phrase further teaching is necessary indicates that the answer will contain incorrect information.
The phrase client understands the teaching indicates that the answer will be correct information. Discussion 28 Paper: Adjectives
NCLEX Strategies
3. Reword the question stem in your own words so that it can be answered with a yes or a no, or with a specific bit of information. Discussion 28 Paper: Adjectives
Begin your questions with what, when, or why. We will practice this strategy with some examples.
4. If you can’t complete previous step, read the answer choices for clues.
Clues
NCLEX Strategies
Class Activity #1- A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?
“Six lesions noted on buttocks at various stages of healing.”
“Multiple lesions on buttocks due to child abuse.”
“Lesions on buttocks due to unknown causes.”
“Several lesions on buttocks caused by cigarettes.”
NCLEX Strategies
Example question
A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?
“Six lesions noted on buttocks at various stages of healing.”
“Multiple lesions on buttocks due to child abuse.”
“Lesions on buttocks due to unknown causes.”
“Several lesions on buttocks caused by cigarettes.”
The first step to correctly answering NCLEX-RN exam questions is to find out what each question is really asking.
1-Read the question stem carefully.
NCLEX Strategies
Example question
A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?
2-Look for hints in the wording of the question stem.
Most appropriately tells you that you need to select the best answer.
NCLEX Strategies
Example question
A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?
1.“Six lesions noted on buttocks at various stages of healing.”
2.“Multiple lesions on buttocks due to child abuse.”
3.“Lesions on buttocks due to unknown causes.”
4.“Several lesions on buttocks caused by cigarettes.”
3-Reword the question stem in your own words.
“What is the best charting for this situation?”
NCLEX Strategies
Example question
A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?
1.“Six lesions noted on buttocks at various stages of healing.”
2.“Multiple lesions on buttocks due to child abuse.”
3.“Lesions on buttocks due to unknown causes.”
4.“Several lesions on buttocks caused by cigarettes.”
4- Because you were able to reword the question, the fourth step is unnecessary
You didn’t need to read the answer choices for clues.
NCLEX Strategies
Example question
A preschooler with a fractured femur is brought to the emergency room by her parents. When asked how the injury occurred, the child’s parents state that she fell off the sofa. On examination, the nurse finds old and new lesions on the child’s buttocks. Which of the following statements most appropriately reflects how the nurse should document these findings?
1.“Six lesions noted on buttocks at various stages of healing.”
2.“Multiple lesions on buttocks due to child abuse.”
3.“Lesions on buttocks due to unknown causes.”
4.“Several lesions on buttocks caused by cigarettes.”
Explanatory notes
The Reworded Question: “What is good charting?”
Step 1. Do not look at any of the answer choices except for answer choice (1). Thoughtfully consider each answer choice individually.
Step 2. Read answer choice (1). Does it answer the question, “What is good charting for this situation?”
(1) “Six lesions noted on buttocks at various stages of healing.” Is this good charting? Maybe. Leave it in for consideration.
Step 3. Repeat the process with each remaining answer choice.
(2) “Multiple lesions on buttocks due to child abuse.” Is this good charting? No, because the
nurse is making a judgment about the cause of the lesions.
3) “Lesions on buttocks due to unknown causes.” Is this good charting? Maybe. Leave it in for consideration.
(4) “Several lesions on buttocks caused by cigarettes.” Is this good charting? No. The question does not include information about how the lesions occurred.
Step 4. Answer choices (1) and (3) remain.
Step 5. Reread the question to make sure you have correctly identified the Reworded Question. This question asks you to identify good charting.
Step 6. Which is better charting? “Six lesions noted on buttocks at various stages of healing,” or “Lesions due to unknown causes”? Good charting is accurate, objective, concise, and complete. It must reflect the client’s current status. The correct answer is (1).
Some students will select answer (3), thinking, “How can I be sure about the stages of healing?” But the purpose of this question is to test your ability to select good charting.
Select the answer choice that shows you are a safe and effective nurse. Remember, questions on the NCLEX-RN® exam are not designed to trick you. Stay focused on the question.
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NCLEX Strategies
Class Activity #2- A construction worker is admitted to the hospital for treatment of active tuberculosis (TB). The nurse teaches the client about TB. Which of the following statements by the client indicates to the nurse that further teaching is necessary?
“I will have to take medication for 6 months.”
“I should cover my nose and mouth when coughing or sneezing.”
“I will remain in isolation for at least 6 weeks.”
“I will always have a positive skin test for TB.”
The correct answer is (c). You “know” this is the correct answer because you’ve eliminated the other three answer choices. The client does not need to be isolated for 6 weeks. The client’s activities will be restricted for about 2–3 weeks after medication therapy is initiated.
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NCLEX Strategies
Class Activity #3: Apply the previous steps to answer the following question.
A woman admitted to the hospital in premature labor has been treated successfully. The client is to be sent home on an oral regimen of terbutaline (Brethine). Which of the following statements by the client indicates to the nurse that the client understands the discharge teaching about the medication?
“As long as I take my medication, I can be sure I will not deliver prematurely.”
“It is important that I count the fetal movements for one hour, twice a day.”
“I may feel a rapid heartbeat and some muscle tremors while on this medication.”
“Bed rest is necessary in order for the medication to work properly.”
If you are focused on the question, you will select (C).
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NCLEX Strategies
Strategy review:
1-Read the question stem carefully.
The first step to correctly answering NCLEX-RN exam questions is to find out what each question is really asking.
2-Look for hints in the wording of the question stem.
The adjectives
The phrase further teaching
The phrase client understands
3-Reword the question stem in your own words.
“What is incorrect (or wrong) information about TB?”
4-You didn’t need to read the answer choices for clues.
Think of priority, ABC, and safety.
NCLEX Strategies
Objectives:
More Strategy learning aids
Critical thinking
Strategy steps:
What is the question really asking?
Look for hints:
The adjectives
The phrase further teaching
The phrase client understands
Reword the question
Find clues if any
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NCLEXStrategiesthenursingprocessandsafety.pptx
NCLEX Strategies: Getting ready (The Nursing Process)
By: Guillermo Londono RN, MSN/MHA
Dean / Director of Nursing
July 1, 2017
Objectives:
Recognizing Priority Questions key words
Nursing process strategy
Safety strategy
Physiological and Psychosocial Needs
NCLEX Strategies
Recognizing Priority Questions key words
You will recognize priority questions on the NCLEX-RN exam because they will ask you what is the:
“best,”
“most important,”
“first,”
or “initial response” by the nurse.
NCLEX Strategies
Recognizing Priority Questions
Students will be caring for clients who have multiple problems and needs.
Students must be able to establish priorities by deciding which needs take precedence over the other needs.
Example: Students probably recognized the baby’s jerky movements as an indication of hypoglycemia.
NCLEX Strategies
Recognizing Priority Questions
Don’t forget that an important part of the assessment process is validating what you observe.
Students must complete an assessment before you analyze, plan, and implement nursing care.
The critical thinking required for priority questions is for you to recognize patterns in the answer choices.
By recognizing these patterns, students will know which path you need to choose to correctly answer the question.
NCLEX Strategies
Recognizing Priority Questions
There are three strategies to help you establish priorities on the NCLEX-RN exam:
Maslow strategy
Nursing process strategy
Safety strategy
NCLEX Strategies
We will outline each strategy, describe how and when it should be used, and show you how to apply these strategies to exam-style questions.
By using these strategies, you will be able to eliminate the second-best answer and correctly identify the highest priority.
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Strategy Two: Nursing Process (Assessment versus Implementation)
Strategy Two: Nursing Process
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Strategy Two: Nursing Process (Assessment versus Implementation)
A second strategy that will assist you in establishing priorities involves the assessment and implementation steps of the nursing process.
On the NCLEX-RN exam, you will be given a clinical situation and asked to establish priorities.
The possible answer choices will include both the correct Assessment and Implementation for this clinical situation.
How do you choose the correct answer when both the correct assessment and implementation are given?
NCLEX Strategies
Think about these two steps of the nursing process.
As a nursing student, you have been drilled so that you can recite the steps of the nursing process in your sleep—assessment, analysis, planning, implementation, and evaluation. In nursing school, you did have some test questions about the nursing process, but you probably did not use the nursing process to assist you in selecting a correct answer on an exam.
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Assessment keywords
adaptations
ascertain
assess
check
collect
communicate
determine
find out
gather
identify
inform
inspect
monitor
nonverbal
notify
observe
obtain information
perceptions
question
verify
Strategy Two: Nursing Process (Assessment versus Implementation)
Assessment is the process of establishing a data profile about the client and his or her health problems.
The nurse obtains subjective and objective data in a number of ways:
talking to clients, observing clients and/or significant others
taking a health history, performing a physical examination
evaluating lab results
collaborating with other members of the health care team.
NCLEX Strategies
Strategy Two: Nursing Process (Assessment versus Implementation)
Once you collect the data, you compare it to the client’s baseline or normal values.
On the NCLEX-RN exam, the client’s baseline may not be given, but as a nursing student you have acquired a body of knowledge. Discussion 28 Paper: Adjectives
On this exam, you are expected to compare the client information you are given to the “normal” values learned from your nursing textbooks.
It is essential that you complete the assessment phase of the nursing process before you implement nursing activities.
This is a common mistake made by NCLEX-RN exam takers: don’t implement before you assess.
NCLEX Strategies
Assessment is the first step of the nursing process and takes priority over all other steps.
REMEMBER
Strategy Two: Nursing Process (Assessment versus Implementation)
Implementation is the care you provide to your clients.
Implementation includes:
assisting in the performance of activities of daily living (ADLs).
counseling and educating the client and the client’s family.
giving care to clients, and supervising and evaluating the work of other members of the health team.
NCLEX Strategies
Implementation Keywords
action
assist
change
counsel
delegate
dependent
facilitate
give
Implement
independent
inform
instruct
interdependent
method
motivate
perform
procedure
provide
refer
strategy
supervise
teach
technique
treatment
Strategy Two: Nursing Process (Assessment versus Implementation)
Nursing interventions may be independent, dependent, or interdependent.
Independent interventions are within the scope of nursing practice and do not require supervision by others.
Instructing the client to turn, cough, and breathe deeply after .
Dependent interventions are based on the written orders of a physician.
On the NCLEX-RN exam, you should assume that you have an order for all dependent interventions that are included in the answer choices.
NCLEX Strategies
This may be a different way of thinking from the way you were taught in nursing school.
Many students select an answer on a nursing school test (that is later counted wrong) because the intervention requires a physician’s order. Discussion 28 Paper: Adjectives
Everyone walks away from the test review muttering, “Trick question.”
It is important for you to remember that there are no trick questions on the NCLEXRN exam.
You should base your answer on an understanding that you have a physician’s order for any nursing intervention described.
Interdependent interventions are shared with other members of the health team. For instance, nutrition education may be shared with the dietitian. Chest physiotherapy may be shared with a respiratory therapist.
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Strategy Two: Nursing Process (Assessment versus Implementation)
The following strategy
Utilize the assessment and implementation phases of the nursing process.
It will assist you in selecting correct answers to questions that ask you to identify priorities.
NCLEX Strategies
Strategy Two: Nursing Process (Assessment versus Implementation)
STEP 1: use the Nursing Process (Assessment vs. Implementation) strategy.
Read the answer choices to establish a pattern.
If the answer choices are a mix of assessment/validation and implementation
STEP 2- Refer to the question to determine whether you should be assessing or implementing.
If after Step 2 you find that, for example, it is an assessment question, eliminate any answers that clearly focus on implementation.
STEP 3- Eliminate answer choices, and then choose the best answer (PRIORITY).
NCLEX Strategies
Class activity #3: Apply, analyze and use critical thinking
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident.
Put him in semi-Fowler’s position for comfort.
Check the pedal pulse and blanching sign in both legs.
NCLEX Strategies
Strategy Two: Nursing Process (Assessment versus Implementation)
Practice question.
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident.
Put him in semi-Fowler’s position for comfort.
Check the pedal pulse and blanching sign in both legs.
NCLEX Strategies
Assessment vs. Implementation
The answer choices are a mix of assessment/validation and implementation
The words “ first action” tell you that this is a priority question.
The Reworded Question: What is the highest priority for a fractured femur?
Step 1. Read the answer choices to establish a pattern.
The answer choices are a mix of assessment/validation and implementation. Use the Nursing Process (Assessment vs. Implementation) strategy. Discussion 28 Paper: Adjectives
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Strategy Two: Nursing Process (Assessment versus Implementation)
Practice question.
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident. (eliminate)
Put him in semi-Fowler’s position for comfort (no respiratory distress)
Check the pedal pulse and blanching sign in both legs. (eliminate)
NCLEX Strategies
Eliminate answer choices, and then choose the best answer.
Step 3. Eliminate answer choices, and then choose the best answer.
Eliminate answers (2) and (4) because they are assessments. This leaves you with choices (1) and (3).
Which takes priority: immobilizing the affected limb, or placing the boy in a semi-Fowler’s position to facilitate breathing?
The question does not indicate any respiratory distress.
The correct answer is (1), immobilize the affected limb.
Some students will choose an answer involving the ABCs without thinking it through. Students, beware. Use the ABCs to establish priorities, but make sure that the answer is appropriate to the situation. In this question, breathing was mentioned in one of the answer choices. If you thought of the ABCs immediately without looking at the context of the question, you would have answered this question incorrectly.
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Strategy Two: Nursing Process (Assessment versus Implementation)
A boy was riding his bike to school when he hit the curb. He fell and hurt his leg. The school nurse was called and found him alert and conscious, but in severe pain with a possible fracture of the right femur. Which of the following is the FIRST action that the nurse should take?
Immobilize the affected limb with a splint and ask him not to move.
Make a thorough assessment of the circumstances surrounding the accident (eliminate)
Put him in semi-Fowler’s position for comfort.
Check the pedal pulse and blanching sign in both legs (eliminate)
NCLEX Strategies
Determine whether you should be assessing or implementing.
The words “ first action” tell you that this is a priority question.
Implementation
Step 2. Refer to the question to determine whether you should be assessing or implementing. According to the question, the nurse has determined that the boy has a possible fracture.
This implies that the nurse has completed the assessment step. It is now time to implement. Discussion 28 Paper: Adjectives
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Strategy Three: SafetyNurses have the primary responsibility of ensuring the safety of clients.
This includes clients in health care facilities, in the home, at work, and in the community.
Safety includes:
meeting basic needs (oxygen, food, fluids, etc.)
reducing hazards that cause injury to clients (accidents, obstacles in the home)
decreasing the transmission of pathogens (immunizations, sanitation).
NCLEX Strategies
Remember that the NCLEX-RN exam is a test of minimum competency to determine that you are able to practice safe and effective nursing care. Discussion 28 Paper: Adjectives
Always think safety when selecting correct answers on the exam.
When answering questions about procedures, this strategy will help you to establish priorities.
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Strategy Three: Safety
STEP 1- Are all the answer choices implementations? If so, use the Safety strategy.
STEP 2- Can you answer the question based on your knowledge? If not, continue to Step 3.
STEP 3- Ask yourself, “What will cause the client the least amount of harm?” and choose the best answer.
NCLEX Strategies
Strategy Three: Safety
Practice question
A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?
Institute measures to minimize crying.
Perform postural drainage every 2 hours.
Cough and deep-breathe every hour.
Give ice cream as tolerated.
NCLEX Strategies
Step 1- Are all the answer choices implementations?
YES
The Reworded Question: What should you do after a tonsillectomy?
Step 1. Are all the answer choices implementations? Yes.
Step 2. Can you answer the question based on your knowledge of a tonsillectomy? If not, continue to Step 3.
Step 3. Ask yourself, “What will cause the client the least amount of harm?”
Answer choice (1), minimizing crying, will help prevent bleeding. Keep in consideration. Answer choice (2), postural drainage, may cause bleeding. Eliminate. Answer choice (3), coughing and deep-breathing, may cause bleeding. Eliminate. Answer choice (4), giving ice cream, may cause the child to clear his throat, causing bleeding. Eliminate. The correct answer is (1). The nurse must prevent postoperative hemorrhage, a complication seen after this type of surgery. Crying would irritate the child’s throat and increase the chance of hemorrhage.
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Strategy Three: Safety
Practice question
A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?
Institute measures to minimize crying.
Perform postural drainage every 2 hours.
Cough and deep-breathe every hour.
Give ice cream as tolerated.
NCLEX Strategies
Step 2. Can you answer the question based on your knowledge of a tonsillectomy?
If not, continue to Step 3. Discussion 28 Paper: Adjectives
The Reworded Question: What should you do after a tonsillectomy? Step 1. Are all the answer choices implementations? Yes.
Step 2. Can you answer the question based on your knowledge of a tonsillectomy? If not, continue to Step 3.
Step 3. Ask yourself, “What will cause the client the least amount of harm?”
Answer choice (1), minimizing crying, will help prevent bleeding. Keep in consideration. Answer choice (2), postural drainage, may cause bleeding. Eliminate. Answer choice (3), coughing and deep-breathing, may cause bleeding. Eliminate. Answer choice (4), giving ice cream, may cause the child to clear his throat, causing bleeding. Eliminate. The correct answer is (1). The nurse must prevent postoperative hemorrhage, a complication seen after this type of surgery. Crying would irritate the child’s throat and increase the chance of hemorrhage. Discussion 28 Paper: Adjectives
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Strategy Three: Safety
Practice question
A child undergoes a tonsillectomy for treatment of chronic tonsillitis unresponsive to antibiotic therapy. After surgery, the child is brought to the recovery room. Which of the following actions should the nurse include in the child’s plan of care?
Institute measures to minimize crying.
Perform postural drainage every 2 hours (cause bleeding)
Cough and deep-breathe every hour (cause bleeding)
Give ice cream as tolerated (cause bleeding)
NCLEX Strategies
Step 3. Ask yourself, “What will cause the client the least amount of harm?”
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